Calumet ElectRx List

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International Mail Order Program

Calumet offers a great option for you to save money on certain brand name prescription drugs through the Elect Rx International Mail Order Program. This program is known as Personal Importation or PI. You can order your brand name drugs from Canada, New Zealand, Australia and England using the same “brick and mortar” pharmacies that people in these countries use for their medications. Plan Members can purchase medication at significantly reduced cost, in some instances, for FREE! ElectRx is a confidential third-party program following all appropriate HIPAA regulations. Here is how you can begin using the program. Enroll today and receive a one-time $200 gift card!

1. Included with this document, is a list of brand name prescription drugs that are offered through the Elect Rx Personal Importation Program (PI). Review this list and see if any of the medications you are currently taking can be filled through the Personal Importation (PI) Program. We are constantly updating this list. Call Customer Service if you do not see your drug listed. You can order up to a 90-day supply of any brand name medication that is eligible for dispensing through this program.

2. Members can enroll by calling (855)353-2879. A Customer Service Representatives will complete the enrollment process and order for you. You will be asked several questions related to your medical condition including any known allergies and a list of the prescription drugs you are currently taking. You should have those prescription drugs with you when you make the call.

3. Have your Physician prepare a prescription with 3 refills and FAX it to the Elect Rx Toll Free Number at (833) 353-2879. Again, you have a $0 co-pay on your prescription and subsequent refills. You will receive an automated reminder notification of a pending renewal/refill. Shipping takes 5-15 business days from the date of completed requirements Tip: Have a 30-day supply on hand to allow for plenty of delivery time.

Elect Rx Customer Service: (855) 353-2879

Elect Rx Physician Fax: (833) 353-2879 or Escribe to:

A & M Pharmacy, 8282 Woodward Ave. Detroit, MI 48202 NCPDP 2338514 Fax-313-875-2869

Customer Service Email: info@electrx.com

Calumet

Available Drug List

Personal Importation Program (90-day supplies)

Brand Medications Available Through Elect Rx

Please call Customer Service if you do not see your Drug listed!

Actemra

Elect Rx Customer Service: 1-855-353-2879

Open 8:30AM to 4:30PM M-F

Physician Fax: 1-833-353-2879

Aklief Cream Combigan Fosamax D Lotemax Eye Drops Otezla* Stelara* Verquvo 10mg

Alecensa* Combipatch Frova Lupron Depot Oxytrol Stendra Verzenio*

Alphagan Combivent Genotropin Lynparza* Ozempic Stiolto Viberzi

Alvesco Copaxone Genvoya* Mayzent - 0.25MG* Pentasa Stivarga Votrient*

Amjevita

Anoro

Arazlo Lotion Denavir Cream Glyxambi Mekinst - 2MG* Promacta* Sutent - 25MG* Vyzulta

Arnuity Ellipta Dovato Grastek Migranal Pulmozyme* Sutent

Asmanex

Atrovent Duobrii Ibrance* Motegrity Qvar Inhaler Symtuza* Xeljanz

Aubagio* Dymista Imbruvica* Multaq Qvar Redihaler Synarel Xeljanz XR

Avonex Edecrin Incruse Ellipta Myfembree Rebif Synjardy Xifaxan - 200MG

Azelex Edurant Intelence Myleran Restasis Taclonex Xifaxan - 550MG

Azilect Eliquis Invega Myrbetriq Rexulti Tafinlar* Xigduo XR

Baqsimi Elmiron Iressa* Neupro Ridaura Tagrisso* Xiidra

Basaglar Emcyt Isentress* Nexavar* Rinvoq Taltz* Xtandi

Benlysta Emtriva Isentress HD* Nexletol Ryaltris Nasal Spray Tarceva* Zeposia*

Betoptic S Enbrel* Jakafi* Nexlizet Rybelsus Tasmar Ziana Gel

Bevespi Aerosphere Entocort Janumet Nextstellis Sancuso Tivicay* Zolinza*

Biktarvy* Entresto Janumet XR Nitrolingual Santyl Ointment Toujeo Solostar Zomig Spr

Binosto Entyvio* Januvia Nocdurna Saxenda Toviaz Zovirax Cream

Bosulif 100mg* Erleada* Jardiance Norditropin Selzentry* Trelegy Ellipta

Bosulif 500mg* Esbriet Jublia Topical Solution Nubeqa Serevent Tremfya*

Breo Ellipta Eucrisa Ointment Juluca* Nucala Silenor Tresiba

Breztri Aerosphere Evotaz Kaletra* Nurtec ODT Simbrinza Trintellix

Brilinta Exelon Patches Kerendia Ocaliva* Skyrizi Triumeq*

Briviact Fareston Kesimpta* Ocrevus Soliqua Trulance

Cabometyx* Farxiga Lacrisert Odefsey Somatuline* Trulicity 0.75mg

Cardura XL Ferriprox Latuda Ofev 100MG* Soolantra Trulicity 1.5mg

Cequa Fetzima Lenvima* Ofev150MG* Spiriva Tykerb

Cimzia Flovent Lexiva* Oralair Spiriva Respimat Uceris

Flovent HFA Inhaler Linzess Orilissa Sprycel*

Medications must be filled a minimum of one time through the Employer RX Benefit Plan.

*This medication will only be dispensed as a one month supply due to the high cost of this medication.

3.24

Drug Name Drug Name Drug Name Drug Name Drug Name Drug Name Drug Name
Ciprodex Ear Drops Forteo Lonsurf Orthovisc Steglatro Velphoro
Creon Gilenya* Mayzent - 2MG* Prestalia Sustiva Vraylar
Ellipta Daraprim Gleostine Mekinst - 0.5MG* Prezista* Sutent - 12.5MG* Vumerity
- 50MG* Wakix
Dulera Humira* Mirvaso Qulipta 30mg Symbicort Inhaler Xarelto

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